CMS Meets Deadline for Approving Healthy Families Transition

Tight up against the end-of-year deadline, CMS officials on Dec. 31 granted approval of California’s plan to move 860,000 Healthy Families children into Medi-Cal managed care programs.

Federal officials asked for changes to the transition plan, including more frequent monitoring and evaluation of the transition to better ensure children are able to access primary care physicians under the new plan.

The first phase of the transition started Tuesday, Jan. 1.

“I wouldn’t say they were additions [to the transition plan] — it was a question of timing more than additions,” said Jane Ogle, deputy director at the Department of Health Care Services. “Some of the monitoring efforts we were already going to do, we were going to do quarterly. Now we’re going to do those monthly. It’s a workload, but we agreed to do it.”

Access to care is the big issue, she said. “Their main concern, and ours too, is that kids are able to see a primary care physician,” Ogle said.

Increased monitoring was good news to Kelly Hardy, director of health policy for Children Now.

“We’re pleased CMS is requiring the state to make contingency plans if children are having trouble accessing care … and that the state will be required to survey beneficiaries [monthly] about their experience with the transition,” Hardy said.

She remains worried that the transition will move too quickly. On Dec. 19, the state inadvertently sent 2,643 identification cards to the wrong Healthy Families beneficiaries. Hardy said that’s an indication that the state may not have the proper safeguards in place to move that many children smoothly into Medi-Cal programs.

“We remain concerned that this transition is being unnecessarily rushed,” Hardy said. “The fact that over 2,600 ID cards were recently sent to the wrong address illustrates this haste. The Legislature did not impose these rushed deadlines. They are self-imposed and simply don’t allow the time for a thoughtful transition.”

According to Ogle, the computer error last month has nothing to do with the beginning of this month’s transition.

“That’s independent of whether or not the state is ready for the transition,” Ogle said. “Accidents happen. We found it and corrected it. In terms of the state being ready … we’ve done this transition in a phased way.”

The first two phases are relatively straightforward, she said, so that the state will have quite a lot of time before implementing the third and fourth phases. The third phase isn’t slated to begin until Aug. 1.

In the meantime, Ogle said, DHCS has stepped up its monitoring efforts, independent of federal approval.

“In the short term, we are constantly having check-ins with health plans about plan access,” Ogle said. “Getting feedback on call centers and any grievances … so we can at least get an anecdotal sense of where there might be issues.”

DHCS plans to continue daily check-ins with plan contractors, Ogle said, “for the duration of the transition.”

A CMS official said children’s care will be improved under California’s new program.

“The modifications made by the state in this program will improve the care kids in Medi-Cal receive by creating administrative efficiencies as a result of operating a single program and will improve coordination across all insurance affordability programs,” said Alper Ozinal, a spokesman for CMS.

“These modifications will also deliver more robust benefits for kids and some will also benefit from lower cost-sharing. We are committed to working with California to ensure that as these modifications are made, all children in the Medi-Cal program continue to have access to comprehensive, high-quality services, including medical, behavioral health and oral health care,” Ozinal said.